Is the "Double Bubble" the Woman in NY Experienced Common?

Is the "double bubble" or four breast affect a potenial side affect of a breast lift/implant procedure? How common is it, and how do you address it with patients?

Doctor Answers 12

The real story about the double bubble

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I admit I read some of the responses about a 'double bubble' deformity after breast augmentation, and all surgeons are not on the same page as to what the term describes. The real deal is that double bubble occurs when the implant used in breast augmentation pushes below the natural fold under the breast. The effect is a breast on a breast look, with a peculiar pear shape. The implant volume and diameter are too large to fit into the natural skin envelope of the breast. It is possible to see this begin to happen during the procedure and can and should be corrected at the time by changing the implant size and shape, and re-fixing the natural fold to the chest wall. A double bubble is a poor outcome and is preventable. The risk should be very small in an experienced practice. Interestingly, the double bubble is not seen in breast lift because the skin envelope is quite large and would not push the implant below the breast.

You may be concerned about the implant sitting up on top in the upper part of the breast in augmentation with lift with the breast sagging over the surface of the implant. Not a double bubble, but still not so nice, and again with an experienced surgeon the implant should be positioned within the breast so that they look and feel as one. If your surgeon is talking about something else, keep looking.

Best of luck,


Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Fixing double bubble problems with implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The double bubble deformity is more common than most of us would like to admit, but there are no available statisitcs to know exactly how often it occurs. I believe there is more than one factor that contributes to it, which is why it has been histroically difficult to fix. However, there are very good options now.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Double Bubble

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A double bubble can happen for a variety of reasons. It can happen with a weak fold, or undermining of the fold. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You might also like...

More common in augmentation with sagging breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

When women with saggy breasts want to go bigger, I usually advise doing a breast lift along with the implants. Otherwise, the implants create what we call a “double bubble,” where the breast droops off the end of the implant like a sock. Some of my patients, however, don’t want a lift because they want to avoid additional scarring, so sometimes implants alone can fill out the skin and eliminate the saggy appearance.

However, it is difficult to determine what treatment method would be best for you without a photo. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants. If you just want to go bigger, the only way to do that is with implants.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

The Double Bubble breast deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi there-

When experienced immediately after surgery, this is an entirely preventable deformity that results from inexperience and poor surgical planning. 

Selecting a surgeon appropriately and carefully should keep you from having to deal with this problem. 

In some patients, however, it results from contracture of the implant related capsule over time- in which case it is necessary to re-operate. In these circumstances, it could happen to any patient and with any surgeon.

This is common

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The problem that you refer as double bubble is a common problem with the combined lift/implant. The reason forthis condition is 1) unrecognized tubular breast 2) implants are too big 3) mistake with the implant positioning

As you see there is no uniform answer to your question and the reason is that there are multiple reasons for this condition.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

Double bubble after breast implants can be prevented.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In most cases, the double bubble deformity after breast implants is a technical error that can be prevented with good planning and good technique. It should be quite rare.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Double bubble after breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Double bubble after augmentation is rare but  can be corrected in most cases and may require a larger higher profiled implant in addition to  some tissue reshaping or a complete lift

Double bubble deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Technically, this can occur with any breast augmentation if the breast tissue falls over the implant. There are techniques to help prevent this, and in experienced hands this should not be a common complication at all. If you are concerned about the risk of this and you are interested in breast augmentation, be sure to ask your surgeon about this specifically during your consultation. Good luck, /nsn.

Double bubble effect in breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This occurs in approx. 10% of all augmentations. It is related to the anatomy of the breast in combination with the inferior insertion of the pectoralis major muscle.

The choices to avoid or correct this are as follows:

1. Live with it (this is an option though I do not recommend to do that)

2. Reoperate with more release of the inferior insertion of the pectoralis muscle

3. Reoperate with doing #2 + inferior scoring of the breast gland

4. Change the location of the implant from sub pectoral to sub fascial or sub glandular

5. The newsest idea as just published in the Cosmetic Surgery Times is Fat transfer to the "double bubble" area (looks very promising, but I have yet to try it).

Hope this gives you an idea upon how difiicult this "double bubble" is to correct.


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.